Occurrence of Septic Shock in a Patient Submitted to Emergency Cerclage following a Negative Amniocentesis: Report of a Case

Abstract

Background: Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed. Methods: A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin. Results: After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital. Conclusion: This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes.

Maternal septic shock secondary to amniocentesis at mid-gestation: A summary of 19 cases, including 2 new Chinese cases, and a literature review

“…Cardiovascular insu ciency, acute renal failure, acute respiratory failure, postpartum haemorrhage, and DIC were all followed in the cases. Extremely high in ammatory factors, including neutrophilic leucocytosis, CRP and PCT, combined with the positive culture all alert the physician to the evolution of sepsis even without marked clinical signs and symptoms [31] . Therefore, it is important to hospitalise patients even with mild symptoms after amniocentesis.…”

Controversies about the Secondary Prevention of Spontaneous Preterm Birth

“…The clinical risks of cerclage are rare, but if they occur, they can be dramatic up to blood loss, severe sepsis, perinatal, neonatal or maternal death [62]. Within many trials and metaanalyses differences in operative skills and surveillance may cause conflicting results but have even been described after negative amniocentesis [63].…”